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Perinatal variables were collected and correlated with mortality at hospital discharge and the diagnosis of grade 2\u20133 BPD at 36\u00a0weeks postmenstrual age (PMA). Placental histology was categorized into three groups: inflammatory pathology, vascular malperfusion, and no pathology. A total of 1128 preterm infants were enrolled, with placental histology results available for 899 cases. Inflammatory placental pathology was associated with a lower gestational age (GA) at birth (\u2212\u20091.4\u00a0weeks, 95% <jats:italic>CI<\/jats:italic>\u2009\u2212\u20091.74 to\u2009\u2212\u20091.11). The increased mortality linked to placental inflammation was no longer significant after adjusting for GA. In preterm infants born at 27\u00a0weeks\u2019 GA or later, the effect of vascular malperfusion on BPD showed sexual dimorphism. In males, placental malperfusion was associated with a 2.25-fold increased risk of developing BPD (95% <jats:italic>CI<\/jats:italic> 1.10 to 4.57), independent of GA and exposure to mechanical ventilation. No significant differences were observed in females born at 27\u00a0weeks or later. <\/jats:p>\n          <jats:p>\n            <jats:italic>Conclusions<\/jats:italic>: The impact of placental histological abnormalities on BPD development is influenced by gestational age and sex. While placental inflammation increases mortality by triggering extremely preterm birth, it does not appear to increase respiratory morbidity compared to cases with normal placental histology at similar GAs. In males, however, placental malperfusion appears to affect lung development and contributes to BPD independently of GA and exposure to mechanical ventilation.\n<jats:table-wrap>\n              <jats:table>\n                <jats:tbody>\n                  <jats:tr>\n                    <jats:td colspan=\"2\">\n                      <jats:bold>What is Known:<\/jats:bold>\u2022\u00a0<jats:italic>Bronchopulmonary dysplasia (BPD) is a common respiratory complication among preterm infants, strongly influenced\u00a0by prenatal events.<\/jats:italic>\u2022\u00a0<jats:italic>The placenta plays a crucial role in fetal lung development, and its analysis provides objective insight into antenatal\u00a0conditions.<\/jats:italic>\n                    <\/jats:td>\n                  <\/jats:tr>\n                  <jats:tr>\n                    <jats:td colspan=\"2\">\n                      <jats:bold>What is New:<\/jats:bold>\u2022\u00a0<jats:italic>Placental malperfusion affects lung development in a sex-specific manner, with male infants born at or after 27\u00a0weeks of gestation being more specifically affected and showing a higher susceptibility to BPD, independent of\u00a0gestational age or mechanical ventilation.<\/jats:italic>\u2022\u00a0<jats:italic>These findings highlight the importance of considering sex differences in BPD pathophysiology and the role of\u00a0placental pathology.<\/jats:italic>\n                    <\/jats:td>\n                  <\/jats:tr>\n                <\/jats:tbody>\n              <\/jats:table>\n            <\/jats:table-wrap>\n          <\/jats:p>","DOI":"10.1007\/s00431-025-06016-9","type":"journal-article","created":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T04:53:06Z","timestamp":1740545586000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Impact of placental pathology on the risk of bronchopulmonary dysplasia in preterm infants: The role of gestational age and sex"],"prefix":"10.1007","volume":"184","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6693-6405","authenticated-orcid":false,"given":"C.","family":"Ramos-Navarro","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7484-0593","authenticated-orcid":false,"given":"R.","family":"Gregorio-Hern\u00e1ndez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"P\u00e9rez-P\u00e9rez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2855-5000","authenticated-orcid":false,"given":"E.","family":"Rodr\u00edguez-Corrales","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5220-8087","authenticated-orcid":false,"given":"S.","family":"Vigil-V\u00e1zquez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1427-1461","authenticated-orcid":false,"given":"M.","family":"Arriaga-Redondo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5121-8291","authenticated-orcid":false,"given":"A.","family":"Merino-Hern\u00e1ndez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9543-7392","authenticated-orcid":false,"given":"M.","family":"S\u00e1nchez-Luna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,26]]},"reference":[{"issue":"10","key":"6016_CR1","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1001\/jama.2015.10244","volume":"314","author":"BJ Stoll","year":"2015","unstructured":"Stoll BJ et al (2015) Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993\u20132012. 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